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Is It Acute or Chronic?teddy bear with arm sling

Knowing when to use heat or cold for injuries is an important thing to know when treating any injury to muscles, tendons, ligaments or soft tissue for that matter.

There are basically 2 types of injuries:

Acute injuries are sudden, often sharp, traumatic injuries accompanied by pain and swelling that occurs immediately (or within hours). Most often acute injuries result from some sort of impact or trauma such as a fall, sprain, or collision and it’s pretty obvious what caused the injury.

Chronic injuries, however, can be subtle and slow to develop. An improperly treated acute injury can result in chronic pain or soreness and impaired mobility if the underlying inflammation or structural damage to the body part involved doesn’t heal properly. Chronic symptoms may resolve over time only to return if the area of the original injury is overused or re-injured.

Cold or Heat Therapy….Do’s and Dont’s

cold and heat therapy
Ice pack or hot water bottle…You decide

Using cold or heat therapy in the wrong circumstances can lengthen the time it takes an injury to heal, and in some cases even make it worse so it’s important to know when to use each type of therapy, how to apply it and for what length of time.

When to use cold therapy….. When you think of cold therapy think acute injury.

The major symptoms of an acute injury to a muscle, tendon, ligament or soft tissue are immediate pain and swelling and often may also make the surrounding joint difficult to move without pain.

Acute injuries should be treated with cold therapy. Since cold constricts blood vessels it will stop the initial swelling by reducing any internal bleeding caused during the injury and will reduce the inflammation over time.

It should be applied in 10 to 15 minute intervals and the skin where the cold treatment is placed should be allowed to return to normal body temperature before another cycle of cold therapy is started.
You can use cold therapy several times per day as long as you allow the area to return to normal temperature before repeating the cycle. Continuing to apply cold too often to an acute injury can actually result in a paradoxical response in which the blood vessels in the area being treated may begin to dilate. This can re-introduce the inflammation and defeat the original purpose of the cold therapy.

Since heat dilates blood vessels and increases circulation it should not be used with acute injuries because it will increase the swelling and inflammation already there and prolong healing time and possibly cause further damage.

When to use heat therapy.

Use heat for chronic injuries and any injury that doesn’t have any inflammation or swelling associated with it.

During exercise muscles can become overworked. When this occurs to the point of the muscle cells being deprived of oxygen, there is a buildup of lactic acid in the muscle causing pain and stiffness. This type of pain and stiffness responds well to heat therapy.

Heat increases circulation to the area its applied to which helps wash out the lactic acid and other chemical by-products of exercise or injury. Heat applied to sore and stiff muscles and joints also causes a relaxing effect in the muscle and tissues in an around the affected joint.

Heat therapy is often used before exercise or other activity such as a sporting event or working outdoors to increase blood flow to a particular area. This helps stiff muscles relax making them less prone to injury.

How to Apply Heat and Cold to an Injury

Knowing how to apply heat or cold to an injury is just as important as knowing which one to use for which type of injury.

Cold therapy can be applied in several ways. Probably the most well know is just a regular ice pack. This can be ice cubes or crushed ice wrapped in a towel or placed in a plastic bag. You can even use a bag of frozen vegetables. The ice pack will be more effective if it conforms to the shape of the area it’s being applied to so the cold is distributed evenly over the injury.

It’s not necessary to place the ice directly on the skin. Very cold therapy packs placed on the skin can actually be painful and cause what I call a “cold burn” almost like a mild frost bite. Placing a thin towel or cloth on the skin over the injury and the ice pack placed on top of that is effective and more comfortable.. The main point is to get the area as cool as possible as soon as possible without causing any further discomfort or damage to the skin.

There are also a number of commercially available cold therapy products that you can use in place of ice. Some are designed to be frozen and used just like an ice pack, while others are composed of chemicals that when mixed together by squeezing or shaking their package creates a cold liquid inside that works just like an ice pack.

Cold therapy can also be used to treat the pain and soreness that occurs when an old injury flairs up due to overuse. Even though it’s an old or chronic injury the over-use aspect causes an acute inflammation that responds well to cold.

One word of caution. If the swelling and pain of an acute injury don’t respond to cooling or the swelling and pain increase you should seek medical attention immediately. This usually means there is significant bleeding occurring at the point of injury that can result in serious complications if not attended to quickly.

Heat therapy. Probably the most often used form of heat therapy is a heating pad. There are several types, some with timers or devices that have a lever you can hold closed to keep it on and let go of to turn it off. These are nice safety devices to prevent burning due to over exposure.

Just as with cold therapy it’s important to have something between the skin and the  heat source to keep from burning the skin. The heating pad or other type of heat pack should be applied at 20 minute intervals letting the area cool back to normal temperature before reapplying it.

Moist heat seems to be most effective and less irritating to the skin. Often just a towel soaked in hot water and place on the injured area is an effective way to apply moist heat. There are a number of commercially available products for heat therapy application including moist heating pads, pads that can be warmed in a microwave, and heat packs that can be activated by shaking or squeezing them to mix chemicals inside the pack that create heat when the chemicals come in contact with each other.


This video offers an overview of ice and heat therapy options for healing.


Following the tips in this article will insure you’re promoting healing not hindering it.  If the injury isn’t improving or swelling increases be sure and see your doctor as soon as possible.

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Published inMedical Issues and Injuries

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